HomeMy WebLinkAboutX2021-2368 - Permit Application (2)1=rnt Form Worksheet for Combo Building & Solar Permit A plicationp
F_ Comm'I f— Residential City of Newport Beach -Building Division x2�2G Z J f� 0
NOTE: PLAN CHECK FEES DUE AT TIME OF SIIRMITTAI
j uilding F_ Grading rDrainage [Elec r'Mech Plum Cu yd cutF_ Cu Yd Fill �
Project Address (Not mailing address) C Flood r Fire (- Liq (- Landslide F_N/A Floor Suite No
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Description of Work Use Const Type I '
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# StoriesF7# Units (if Res)
Valuation $ 3/ o�
New/Add SF� Remodel SF�— Garage/New/Add Material/Labor l
OWNER'S NAME Last CUY't741U Spvk. First
Owner's Address Owner's E-mail Address
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City -Zjk t45 RtApr StateFc zip q__i53P TelephoneF777777
APPLICANT'S NAME Last ' First
Applicant's Address Applicant's E-mail Address
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City iyc ri5tvtov -0 State 1444 4' Zip l_ 2), Telephone �M 6 009 I�i 3
ARCHITECT/DESIGNER'S NAME Last
�2gt r First R�yu fro Lic. No. L° 3 C6 ,9
Architect/Designer's Address 3 Lie , Architect/Designer's E-mail Address
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City ��(/{� I q �al� ... �eG.CLL State .. Zip I ,i_(, 7 Telephone %/1 � his a Ji2e
ENGINEER'S NAME Last r4; Z First Lic. No. _5�'(2
Engineer's Address . D (f - ,E— s SOG. , Engineer's E-mail Address
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ity Qfo —e -State I N' Zip 72667 Telephone
RACTOR'S NAME/COMPANY 1AAA Lic. No. 783 4 E3 Class.
hr's Address Contractor's E-mail Address
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SETBACKS FRONT PERMIT NO. XZpZA - 23 I7y
SETBACKS RIGHT PLAN CHECK NO. Z—O7-f - f
DEVELOPMENT NO PLAN CHECK FEES $ _ _